INFORMATION SUPPLEMENT. Ageless

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1 Ageless Beauty cosmetic your guide to enhancement Maybe you dislike that bump on your nose, or wish you could get rid of those pesky love handles. You re not alone. Last year, nearly one million Canadians had cosmetic enhancement and that number grows every year. Changing your appearance no longer requires going under the knife last year 83 per cent of all procedures were non-invasive, which means you can sculpt, shape or smooth most areas of your body using lasers, fillers, and other non-invasive techniques. So what is plastic surgery? Having plastic surgery sometimes carries a negative connotation as though you ll go into the procedure looking natural and come out looking plastic. But the word plastic in plastic surgery is derived from the Greek word plastikos to mould. And that s exactly what plastic surgeons are trained to do. We mould features to correct various problems, explains Dr. Wayne Carman, a Toronto plastic surgeon and president of the Canadian Society for Aesthetic (Cosmetic) Plastic Surgery (CSAPS). Plastic surgery is divided into two subgroups reconstructive surgery (performed as a result of congenital problems or trauma) and cosmetic surgery (which addresses elective changes to your appearance). If you re looking to get some form of cosmetic enhancement, an important consideration is the specialist.

2 Specialist{ How to choose a In Canada, any medically trained doctor can call himself a cosmetic surgeon. While he may decide to perform any procedure from liposuction to facelifts, plastic surgeons and facial plastic surgeons-otolaryngologist head and neck surgeons have several years more training. Thus, they re better equipped to minimize any risks and handle any complications that may arise during surgery. Plastic surgeons: Plastic surgeons are qualified to perform plastic surgery on any part of the body. After completing four years of medical school and a twoyear internship, they fulfill four to five years of surgical residency, in which they learn all facets of surgery, including specialty training in plastic surgery. Then, most plastic surgeons opt to complete one to two years as a clinical fellow exploring a plastic surgery subspecialty (such as breast reconstruction) more exclusively. Plastic surgeons may perform any type of plastic surgery including facial, but also specialize in body procedures such as breast augmentation, breast lifts, tummy tucks and liposuction. Facial plastic surgeons-otolaryngologist Head and Neck Surgeons: These surgeons (referred to as FPS-O here) are trained and qualified to perform reconstructive plastic surgery and cosmetic surgery in the face and neck. After completing their undergraduate program, they enter four years of medical school, then they complete at least five years of specialty training. FPS-Os perform 85 per cent of all rhinoplasty or nasal plastic surgery as well as the majority of head and neck reconstructive surgery. Cosmetic dermatologists: After completing four years of medical school, cosmetic dermatologists enter a dermatology residency program that involves five years of advanced dermatology training. Cosmetic dermatologists then complete advanced medical and surgical training. Additional training will focus on non-invasive cosmetic enhancement procedures such as Botox, facial fillers, lasers for skin tightening and sun damage, microdermabrasion and glycolic acid peels.

3 associations Many specialists belong to associations, academies or societies that recognize their years of training and expertise. When you re looking for a specialists, it s helpful to check to see if they belong to an association that validates their credentials. CSAPS: Canadian Society for Aesthetic (Cosmetic) Plastic Surgery This society, founded in 1972, is a Canadian professional organization dedicated to improved cosmetic surgery outcomes through the maintenance of high surgical standards as well as education and research. It represents more than 160 fully trained and qualified Canadian plastic surgeons who have demonstrated their commitment to excellence in the area of cosmetic surgery. The CSAPS website ( provides a complete list of all its members. CAFPRS: Canadian Academy of Facial Plastic & Reconstructive Surgery This association, founded in 1981, represents fully trained and qualified Canadian surgeons who have specialized interest in facial plastic surgery. On average, CAFPRS members each perform about 700 facial cosmetic reconstructive and non-invasive procedures a year including facelifts, browlifts nose surgery and eyelifts. The CAFPRS website (www. cafprs.com) provides a complete list of all its members. { In the past five years, Dr. Carman has seen a 10 per cent increase in the number of men getting forms of cosmetic enhancement. Topping the list is liposuction... Trends among women While breast augmentation has always been a popular request among women, in the last two years it has surpassed liposuction as the most popular procedure and in the past decade the number of women getting breast augmentation in North America has tripled. Breast reduction can now be done with liposuction to limit scarring (though this technique is usually not covered by insurance). While facelifts have always been a popular treatment for women, doctors are now recommending fat transfer to plump up the face. The hidden perk: fat is extracted from the tummy or hip area using a fine cannula (an instrument used in liposuction). Then, it s injected using even smaller needles into the lips, cheeks, depressed scars, and even an indent in the breast after a biopsy. Trends among men While women are more likely to get cosmetic enhancement, men are now doing more than ever before, says Dr. Carman, adding that in the past five years, he s seen a 10 per cent increase in the number of men getting forms of cosmetic enhancement. Topping the list is liposuction particularly in the tummy, love handles and chest area. Men are also getting fat injections in their faces for a quick alternative to a facelift without scarring or signs to indicate work has been done making a big change without much time or recovery, says Dr. Carman. surgical treatments Rhinoplasty Every year, more than half a million North Americans undergo rhinoplasty, one of the most popular procedures. Even the slightest alteration can improve your overall look, says Dr. Kris Conrad, an FPS-O in Toronto and Associate Professor at the University of Toronto. What s new? The common goal now is to create a timeless nose rather than an operated-on nose, says Dr. Philip Solomon, an FPS-O in Thornhill, Ont. If necessary, doctors may also perform a chin augmentation at the same time as a rhinoplasty, to ensure the nose and chin are aligned. They can also use injectables to correct any imperfections in the nose post-surgery. Facelift One of the most popular procedures among women in their 50s, a facelift tightens sagging tissues, making skin look firmer and younger. Most facelifts are actually performed on the lower two-thirds of the face and usually include the neck, so if you re looking to reduce forehead wrinkles, you ll also need a forehead lift or a browlift. Your surgeon may also recommend a neck lift, to tighten lax skin for a more cohesive look. What s new? The combination of smaller incision facelifts combined with volume enhancement with fillers or micro-fat transfer allow us to obtain very natural and beautiful results, explains Dr. Andres Gantous, an FPS-O and Assistant Professor at the University of Toronto. And whereas a traditional facelift can create large scars around the ear, highly trained surgeons can now create smaller incisions, causing less noticeable scarring.

4 Last year, nearly one million Canadians had cosmetic enhancement, and that number grows every year. Browlift To reduce forehead wrinkles, you ll need a browlift. The endoscopic approach involves making several small incisions then using fine instruments to modify the forehead muscles to decrease wrinkles and lift eyebrows. The open approach creates a cut across the top of the scalp, hidden in the hair. Then the parts of the muscles that cause frown lines, as well as excess skin, are removed or modified. To avoid a surprised look, Dr. Conrad ensures that the eyebrows are reshaped during the operation, rather than simply lifted. What s new? Botox injectable fillers and laser resurfacing can be combined with this procedure for either a subtle or more dramatic look, says Dr. Peter Adamson, an FPS-O in Toronto. A new procedure, the short scar mini browlift, smoothes the temple area, may take less than an hour to perform and can improve the hooding of the upper eyelid, which often starts in your early 40s, says Dr. Richard Rival, an FPS-O in Newmarket, Ont. and Toronto. Breast augmentation Breast augmentation uses saline or silicone gel-filled implants to change the shape and size of your breasts. Cohesive silicone gel implants may feel more natural and are less likely to rupture or cause problems, meaning the only reason you d have them replaced is if you wanted to change the size or shape. What s new? If you ve had a breast biopsy, we can now fill the indent by removing fat from your mid-section and injecting it in your breast, says Dr. Carman. For breast lifts, surgeons can use shorter scars to enhance the shape in a less invasive way. Tummy Tuck This procedure is used to remove loose skin and excess fat, and tighten the muscle layers of the abdomen, particularly after childbearing. The incision is hidden in the bikini line, so you can wear a bikini without showing the scar. You may not know: You should wait until at least four months after having your last child to have a tummy tuck. Dr. Carman explains, Having another pregnancy right after a tummy tuck is not harmful, but it will reverse some of the benefits of the procedure. Liposuction Liposuction uses cannulas, to reduce fatty deposits in both men and women s legs, love handles, knees, arms and chest the latter of which is particularly popular with older men or under the chin to reduce the double chin effect. What s new? Body-Jet gentle water liposuction, the newest state-of-the-art liposuction, made its debut in Canada this year, and uses pulses of saline to gently remove fat cells and achieve fat reduction and body contouring. Whereas traditional liposuction requires general anesthetic, Body-Jet gentle water liposuction requires only local anesthetic, and because of the gentle pulses of saline there s minimal bruising and a shorter recovery time. Patients are back to work within a day or two (compared with one to two weeks with traditional liposuction), says Dr. Douglas Grace, a plastic surgeon in Burlington, Ont. and founder of The Grace Clinic., who was the second doctor to start using the Body-Jet procedure in Canada.

5 Nonsurgical treatments Injectable fillers While collagen was a popular injectable filler years ago, hyaluronic acid has emerged as the ideal compound because of the ease of injection, lack of hypersensitivity or allergic reactions and its versatility, says Dr. Gantous. It s naturally found in the body, so it s safe and effective. Hyaluronic acid fillers such as Juvéderm, Restylane and Perlane can fill deep wrinkles or superficial lines, plump lips and fill depressed scars. Most last about six months to a year, but for a longer lasting filling, Dr. Gantous recommends Radiesse, a calcium hydroxlapatite filler, which can be used to fill deeper grooves and add volume to the face. Evolence, a collagen fillers, can be used for wrinkles and lips and lasts up to a year. Bio- Alcamid is a polymeric gel that becomes permanent when injected, creating volume the way a surgical implant would, says Dr. Gantous. so it s great for restoring volume to areas of fat loss in the face. What s new? Voluma, the latest addition to the Juvéderm line of fillers adds volume to the face, often delaying the need for a facelift. Juvéderm, Ultra XC and Ultra Plus XC are available with added Lidocaine, a dental freezing, which can make injections pain-free. expert tips { If you re not sure about surgery, wait a while and then talk to your doctor again. Research your doctor s qualifications to ensure you re getting the most qualified surgeon for the procedure. Book a few consultations. Get a referral from friends, family or your physician. Every patient is unique. What might be the perfect procedure for your best friend may not be perfect for you. Cosmetic Botox Botox has been used successfully in more than 80 million people worldwide. When used in small amounts Botox relaxes the muscle to reduce frown lines, crow s feet, forehead lines and lip lines, producing a refreshed and relaxed appearance, says Dr. Fred Weksberg, a Toronto Cosmetic Dermatologist. What s new? Doctors can adjust the dosage to ensure a natural, not frozen look. Using Botox for treatment of hyperhidrosis (excessive sweating) is now popular, since it reduces sweating for about six months. The newest botulinum agent on the market is Xeomin, which works similarly to Botox. Laser skin treatments Lasers can reduce wrinkles, sun spots, large pores and scarring. Infrared lasers heat the dermis, causing soft tissue thickening which results in overall skin tightening. Intense pulse light therapy (IPL) uses light to restore the skin s natural cellular activity, while reducing melanin production, which causes brown spots. What s new? New fractionated CO2 lasers, such as the Smart- Xide, allow doctors to improve skin quality, tighten skin and reduce scarring with very little down time and risk, says Dr. Gantous. The fractional approach delivers an array of small beams (instead of one large beam) which is more effective and results in faster healing, says Dr. David Ellis, an FPS-O in Toronto. Doctors can adjust the dosage to ensure a natural, not frozen look. Using Botox for treatment of hyperhidrosis (excessive sweating) is now popular, since it reduces sweating for about six months. Laser vein therapy Spider veins in the face can be treated using vascular lasers, while varicose leg veins are often treated with sclerotherapy injections that cause the veins to close, thus shriveling up and fading without damaging the normal skin. What s new? Sometimes what s old is new again. While lasers competed with sclerotherapy to treat leg veins for a while, many doctors are returning to the latter to treat leg veins since it s more effective, with no downtime, pain and minimal side effects, says Dr. Weksberg.

6 Laser hair removal Excess hair on any part of the body can be reduced or eliminated through laser hair removal. Because hair cycles through growth and dormant phases, which are a result of many factors such as medication, genetics and hormones, the client is usually treated at least four to six times to reduce the growth, and with subsequent treatments a person can be almost completely rid of their unwanted hair. Our lasers adjust for both fine and coarse hair and, and because it s an Nd: YAG laser, it is very safe to use on all skin types from 1-V1 (light to dark skin), says Sharon Edgley, certified laser technician at Evolution Laser in Toronto. My clients are very happy with their results after six treatments, though we usually do eight to 10 to attain even greater reduction, says Edgley. What s new? Many salons and spas now offer laser hair removal. However, the laser machines at a medically supervised clinic will always ensure better and safer results. Microdermabrasion This treatment uses micro crystals to gently exfoliate the skin, treating acne scarring, hyperpigmentation, uneven texture, age spots or fine lines. After the treatment you ll have a pink glow, and while one treatment is enough to notice a difference, most people get one treatment every few weeks for a total of six treatments. What s new? SilkPeel is one of the most exciting new types of microdermabrasion. It infuses one of four solutions such as hyaluronic acid to hydrate or salicylic acid to reduce acne into the skin. Chemical Peel A chemical peel uses mild glycolic or alpha hydroxyl acid to gently peel off the top layer of skin. Post-peel, your skin will be slightly dry and red, but will soon be glowing and smooth. A TCA peel is stronger, causing redness and scaling for up to a week, though the results are better. What s new? While laser resurfacing has replaced the chemical peel in some treatments in recent years, the chemical peel still has certain advantages over laser resurfacing, says Dr. Weksberg, Laser resurfacing can have more drawbacks, such as residual redness post-treatment that is less common with chemical peels. Veneers Laser vision correction debuted in Canada 20 years ago, and today, most people can have their vision improved, eliminating the need for glasses contacts. Teeth Whitening While there s a bevy of at-home whitening kits you can buy at the drugstore, the most effective way to whiten your teeth is with an inoffice whitening session. Zoom Advanced Power is the best, says Dr. Weiss. A zooming-session takes 90 minutes in the office, incorporating peroxide bleaching gel with light activation to whiten teeth up to eight shades (compared with four shades for whitening strips). What s new? Some dentists now have stronger whiteners for use in trays (but done in-office) that take only one hour to whiten your teeth. { or Veneers Veneers are used to change the shape, size, position or colour of a tooth. Comprised of a thin wafer of porcelain, the veneer covers the front of the tooth, leaving the healthy tooth in the back exposed. The dentist performs a slight filing, then makes an impression of the teeth. For about a week, you wear temporary veneers until the permanent one is ready. Most veneers last 10 to 15 years, though they can last longer. There are only a few reasons to have them replaced: if you get a chip, fracture or a cavity; or to make them whiter, says Dr. Sol Weiss, a Toronto-based dentist. What s new? If you re not sure about getting veneers, you can opt for a no-prep porcelain veneer, such as Lumineers. Your teeth need to be a good colour, as there is very little modification ability, says Dr. Weiss, adding, the teeth need to start off small or with spaces; and the intent is to make bigger teeth or to close spaces. Also new: digital impression machines allow teeth to be scanned and the impression to be ed (rather than couriered) to the lab, resulting in a quicker, more accurate and more comfortable experience for the patient. Cosmetic imaging on a computer can show you what your face will look like with your new smile. Laser vision correction 90 per cent of people wearing glasses between 18 and 50 years old qualify for laser vision correction; of those that qualify 90 percent have Lasik (the preferred procedure where a flap is created in the cornea and then replaced back). Lasik recovery time is under 24 hours for them, says Dr. Mark Cohen, co-owner of Lasik MD. The other 10 per cent of patients that qualify where the cornea is too thin or too weak to create the flap required for Lasik undergo surface laser ablation, also known as Photorefractive Keratectomy (PRK). The recovery for these procedures can take longer, but after three months, the results are identical to Lasik. What s new? About 65,000 Canadians get this procedure every year. Procedure times for Lasik have improved, making it quicker than ever, at an average of eight seconds per eye, for a total procedure time of 10 minutes. Microdermabrasion uses micro crystals to gently exfoliate the skin, treating acne scarring